Archived: Burwood Nursing Home

Updated 8 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This routine comprehensive inspection took place on 23 and 29 January 2018. The first day was unannounced.

The inspection team was comprised of an adult social care inspector and an expert by experience on the first day, with the inspector returning alone on the second day. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed the information CQC held about the service. This included notifications from the service about significant incidents. Due to technical problems on the part of CQC, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also requested feedback from stakeholders, including the local authority, the NHS clinical commissioning group and health and social care professionals who have had contact with the service.

During the inspection, we made general observations around the service and spoke with 14 people who use the service, two visitors and a visiting health professional. We also spoke with four care workers, two registered nurses, two other staff, the deputy manager, the two registered managers and the other owner. We reviewed four people’s care records, medicines administration records, four staff files and other management records.

Following the inspection we requested from the registered managers further information about recruitment, staff training, the provision of activities and involvement in research. They provided this as requested.

Updated 8 August 2018

This comprehensive inspection took place on 23 and 29 January 2018. The first day was unannounced. At our last inspection in August 2015 we rated the service as Good and there were no breaches of the legal requirements.

Burwood Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Burwood Nursing Home accommodates up to 58 people in two adjacent buildings on the same site. One building, known as Burwood, has 16 individual ensuite bedrooms and the other, Yaffle, has 42. Burwood has a communal lounge and dining area, but most communal facilities are located in Yaffle and people in Burwood have ready access to these. When we inspected, there were 52 people living or staying at Burwood Nursing Home. They were older people with physical health needs, most of whom required nursing care. Some were living at the service; others were staying for a limited period of respite or recuperation.

The service had two registered managers. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their visitors were very positive about their or their loved one’s care, and also praised the caring approach of the staff. The service had received compliments about exceptional care and how staff had gone the extra mile to ensure people were as comfortable as possible.

People were treated with kindness, compassion and respect. Their independence was promoted as far as possible, whilst respecting their choices. There was an emphasis on people having choices and their preferences being respected.

People and relatives took part in the interview process for new staff and had an influence over who was recruited.

Staff training had been developed around people’s particular needs; some people and relatives were involved in delivering this. This gave staff first hand insights into people’s conditions. Staff learning needs and styles were taken into account in how training was delivered.

Care and support was tailored to people’s individual needs. People, and where appropriate their relatives, were encouraged to be involved in the care planning and review process.

There was an emphasis on people experiencing a ‘good death’ when the time came, in other words, a dignified, comfortable and pain-free death in the place the person wanted to be. Staff had skills to understand and meet the needs of people and their families in relation to emotional support and practical assistance at the end of a person’s life.

Arrangements for social activities met people’s individual needs; there was an emphasis on people living as full a life as possible. There was an extensive range of optional group and individual activities. They took place both at the service and in the community. The management and staff teams went to great lengths to arrange activities that people really wanted to take part in, based on their interests or expressed wishes.

The service took a key role in the local community and was actively involved in building further links. There were strong links with a range of community organisations, including local churches, schools, the library, community groups and a nearby care home.

The premises had been designed with people’s needs and comfort in mind. People’s rooms had floor length windows, so people had a clear view over the grounds, even from their bed. There were different areas that people regularly used for activities, and also to spend time privately or with visitors. These included the ‘Railway Tavern’, furnished as a traditional pub, and an art deco theatre. All areas were maintained and decorated to a high standard, and kept clean and tidy.

Staff were aware of people’s individual preferences and patterns of eating and drinking and there was flexibility when needed or requested. People had access to plenty of food and drink throughout the day and were enabled to choose where and what they ate. People told us they liked the food and were able to make choices about what they had to eat. They had a choice of areas for dining.

People were encouraged to make choices about how their health needs were managed. Their healthcare needs were monitored and any changes in their health or well-being prompted a referral to their GP or other healthcare professionals. A GP conducted regular weekly visits and was well known to staff at the service. Staff routinely attended hospital appointments with people who wanted this. Healthcare professionals gave positive feedback about people’s care and how people were supported regarding their health. They said the managers and staff communicated well with them.

Technology used in providing the service was easy for staff to use, and promoted timely and responsive care. For example, ‘wheel on’ weighing scales had been provided, as these were simpler and more comfortable for people and staff to use than scales that required people to sit in a sling.

The service worked in partnership with other organisations to keep up to date with developments in best practice. It also contributed to the development of best practice and good leadership with other agencies. The service had sought out opportunities to participate in academic research, and at the time was involved in three projects, with a view to improving further the experience of people living and staying at the service.

The service had a positive culture that was person-centred, open, inclusive and empowering. Both buildings felt like happy, calm, relaxed places. People who used the service, relatives and staff were confident that any concerns they raised would be listened to and acted upon as necessary. People’s concerns and complaints were encouraged, taken seriously and used as an opportunity to improve the service.

Staff were motivated by and proud of the service, taking pride in their work. They told us very clearly about the service’s commitment to care for people in safe, warm, caring comfortable surroundings whilst giving people the dignity and respect they needed to live their lives in an independent manner. Morale was good and the staff worked well together as a team. They were well supported by the management team.

Staff followed the requirements of the Mental Capacity Act 2005, only providing care with people’s consent. Where they had concerns about someone’s ability to give consent to particular aspects of their care, best interests decisions were recorded so the person’s needs were met in the least restrictive way possible.

Risks to people’s personal safety and wellbeing had been assessed and plans were in place to minimise these risks.

People were protected against abuse and avoidable harm. People involved in accidents and incidents were supported to stay safe and action was taken to prevent further injury or harm.

Assessments and care plans flagged up sensory loss or impaired communication and the way in which staff should support them with this. Staff were aware of people’s communication needs.

Peoples’ medicines were managed and administered safely.

The prevention and control of infection were well managed.

There were sufficient staff on duty with the right skills and knowledge to meet people’s individual care needs. Staff were well supported through training and supervision.

Safe recruitment practices were followed before new staff were employed. Checks were made to ensure staff were of good character and suitable for their role, sharing the owners’ values in relation to older people and care.

Quality assurance systems were in place to monitor and where necessary improve the quality of the service. These included annual quality assurance surveys and a range of regular audits. Action was taken to address any shortfalls that were found. The registered managers and deputy manager were supernumerary, but regularly worked alongside staff. This helped them maintain oversight of the quality of care and the culture of the service. It also helped ensure they were readily available for people and staff to discuss any issues or concerns.